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Promoting health or peddling weight loss?

by Deb Burgard, PhD

My challenge – to health care providers, family, fitness and nutrition experts, school officials, our own government and public health agencies – basically, anyone who will listen – is to have the courage to make the argument for health without doing it on the backs of fat people.

It is obvious that creating environments that support human health is not an “obesity prevention” project. Do thin adults and children not deserve access to good nutrition, safe places and abundant opportunities to be physically active, freedom from bullying, teasing, violence, and discrimination? Whatever is good for human bodies is good for all human bodies, not only fat ones.

What is it that distorts the promotion of health into weight loss marketing?

Money is an obvious answer. The weight loss industry is extremely lucrative, and the grant money is flowing to researchers who can spin their projects as “obesity” related. Even people who believe in the Health At Every SizeSM approach are sometimes ambivalent about leaving behind the promise of weight loss, worried that weight loss is the “hook” that makes many people a customer for therapy, nutrition advice, fitness advice, etc.

But I suspect it is more than money. I suspect that many people just don’t believe that it is motivating to try to feel as healthy (energetic, rested, with less pain, more mobility, skilled, respected, and cared for) as possible. They don’t believe people will invest in the practices that support health if they are not doing it to lose weight.

Notice I say “as possible” – because health is not a binary good. It is dynamic, changing every day, changing over our lifetimes. But health feels good. More health feels better than less health. People deserve environments that allow them to be as healthy as they can at any given time. And, in these days of rampant healthism, it needs to be said that whatever degree of health they have does not equate with their moral worth.

I see every day that people are motivated to feel better, that they invest time and effort to do so. But the nearly universal pathway people use to do this is to try to lose weight, because they are told and they believe – despite their own experiences – that weight loss will deliver all those features of health: energy, mobility, respect and care from others. And then what happens? In the vast majority of cases, they are unable to sustain weight loss. The benefits they sought are fleeting or unattainable. So everyone walks away thinking, “well, you/I must not be motivated enough.”

 But what if the fruitless pursuit of weight loss was eliminated from this process? What if the focus could be on creating environments that support the practices that support the health of people of all sizes? What if our science investigated what those environments look like, and what approaches help people invest in those practices – and sustain them – even when they are challenging? What if our policy science investigated what sorts of laws and services support people making such investments?

I think we would see science confirming that discrimination and stigma harm health; that removing barriers to access to medical care, play opportunities, and nutritious food promotes health; and that helping people feel empowered and effective (as opposed to demoralized and re-stigmatized from weight regain) at whatever size, keeps us motivated to continue.

So I challenge us all to see the peddling of weight loss, in whatever guise, as a morally bankrupt act. Make it clear that causing more weight cycling and disordered eating is against the principle to “do no harm.” Tell the people who only have good intentions to take those good intentions and come up with 2-5 years of outcome data that shows sustained weight loss and sustained health outcomes for the majority of people before they inflict their intervention on the public. I challenge us all to demand this minimal standard of proof of value before anyone spends a single dime on weight loss, and before any one of us recommends a weight loss intervention.

Saying no to the pursuit of weight loss is only part of the challenge, though. The other more joyful challenge is to take the effort and ingenuity and hopes we are all capable of, and invest in our well-being right now. Do something for your body every day, and do something for everyone else’s bodies with your activism every day. Let’s prove the cynics wrong.

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